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. 2023 Feb;7(1):36-38.
doi: 10.5811/cpcem.2022.12.58093.

Bilateral Erector Spinae Plane Block for Man o' War Stings: A Case Report

Luke Weber  1 , Michael Shalaby  1
Affiliations

Bilateral Erector Spinae Plane Block for Man o' War Stings: A Case Report

Luke Weber et al. Clin Pract Cases Emerg Med. 2023 Feb.

Abstract

Introduction: The Portuguese man o' war, an aquatic invertebrate, is responsible for a large proportion of cnidarian stings worldwide. Cnidaria is a phylum that contains the genus Physalia. These injuries result in severe pain and skin irritation, which are often difficult to control. Traditionally, cnidarian stings have been treated by emergency physicians with warm water, vinegar and, in severe cases, opioids. However, no concrete guidelines have been established for pain management in man o' war stings.

Case report: Regional anesthesia (RA) is an increasingly used method of pain control in the emergency department. In the case of a 41-year-old female experiencing severe pain from a Portuguese man o' war sting, RA with an erector spinae plane block (ESPB) provided her with rapid and long-lasting pain relief.

Conclusion: The standard of care has yet to be defined when managing pain from Physalia physalis stings. Although this is the first documented use of ESPB for treatment of cnidarian stings, RA should be considered by any emergency physician when treating injuries caused by a Portuguese man o' war.

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Conflict of interest statement

Conflicts of Interest: By the CPC-EM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

Figures

Image 1
Image 1
Erector spinae plane block right posterior chest. Ultrasound image of needle placement just prior to anesthesia injection. Transverse processes (TP) and erector spinae muscle (ES) labeled above.
Image 2
Image 2
Rashes on posterior chest from Portuguese man-o’-war stings.
See this image and copyright information in PMC

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